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PubMed2002

Paediatric orthopaedics in Singapore.

This article traces the development of Paediatric Orthopaedics in Singapore. Ever since the formation of the University Department of Orthopaedics in 1952, orthopaedic surgeons have had a special interest in musculoskeletal problems in children. Special clinics called "Congenital Clinics" were held in the Singapore General Hospital to look after these children. These clinics were continued in the Singapore General Hospital after the University Department moved to the National University Hospital in 1985. In 1987, a Division of Paediatric Orthopaedics was formed at the National University Hospital to streamline the care of children with musculoskeletal problems. In 1997, the new KK Women's and Children's Hospital opened with a Department of Orthopaedic Surgery dedicated to paediatric patients. In the space of 50 years Paediatric Orthopaedics has become an established subspecialty in Singapore.

Child↗
PubMed2004

Twin births in Singapore: a population-based study using the National Birth Registry.

INTRODUCTION: Twin studies are a most effective method to analyse gene and environment interactions. Using data from the Singapore National Registry of Births and Deaths (SNRBD), this paper describes the number of twin and multiple births among different ethnic populations in Singapore. MATERIALS AND METHODS: All births recorded in the SNRBD from 1 January 1986 to 31 December 2001 were analysed. Outcomes measured were twin and triple birth rates (per 1000 maternities) of the 3 main ethnic groups in Singapore (Chinese, Malays and Asian Indians). Further outcomes were calculated using Weinberg's differential rule to estimate the number of monozygotic and dizygotic twins. RESULTS: Overall twin birth rates have steadily increased across all ethnic groups (7 to 9/1000). The largest increase in multiple births among the ethnic groups were twins born to Asian Indian fathers (6.9 to 9.9/1000) and Malay mothers (5.9 to 9.8/1000). A significant difference in birth rates between the ethnic groups was found during the years 1994 to 1997, where Chinese parents had the lowest multiple birth rates and Asian Indians the highest. Estimation and ratios of monozygotic and dizygotic twin births differed among the ethnic groups: Asian Indians had the highest ratios, followed by the Chinese and, lastly, the Malays. CONCLUSION: The SNRBD has provided an overview of multiple births in Singapore, although the establishment of a national twin register would enable more detailed analysis of genetic and environmental effects in multiple births.

Asian People↗
PubMed2004

Refractive errors in medical students in Singapore.

INTRODUCTION: Refractive errors are becoming more of a problem in many societies, with prevalence rates of myopia in many Asian urban countries reaching epidemic proportions. This study aims to determine the prevalence rates of various refractive errors in Singapore medical students. METHODS: 157 second year medical students (aged 19-23 years) in Singapore were examined. Refractive error measurements were determined using a stand-alone autorefractor. Additional demographical data was obtained via questionnaires filled in by the students. RESULTS: The prevalence rate of myopia in Singapore medical students was 89.8 percent (Spherical equivalence (SE) at least -0.50 D). Hyperopia was present in 1.3 percent (SE more than +0.50 D) of the participants and the overall astigmatism prevalence rate was 82.2 percent (Cylinder at least 0.50 D). CONCLUSION: Prevalence rates of myopia and astigmatism in second year Singapore medical students are one of the highest in the world.

Adult↗
PubMed2005

Childhood injuries in Singapore: a community nationwide study.

INTRODUCTION: Childhood injuries are the leading cause of death for children between 5 to 14 years of age in Singapore. However, there is no information or data on childhood injuries in the community in Singapore. There was a need to conduct a nationwide study on childhood injuries in Singapore in order to estimate the prevalence rate, types of injuries, and to identify the hazards in the homes of the children. METHODS: A cross-sectional nationwide study with a two-stage stratified random sampling was conducted to obtain a representative sample of the Singapore population. Families that had children younger than 15 years of age were selected for the study. Parents and caregivers were interviewed at their homes. RESULTS: There were 2322 children in the study, of which 452 had one or more injuries in the past one year, giving an overall prevalence rate of 19.5 percent. Of the children who had injuries, the home was the commonest place where injuries occurred (45 percent) and falls were the leading cause of injuries (77 percent). There were many hazards identified in the homes studied and it was found that the more hazards present in the homes, the more likely it is for the child to get injuries. CONCLUSION: There is a need for educational and interventional programmes to help Singaporeans understand the need to make the home environment safe for children and to prevent home injuries.

Accidents↗
PubMed2005

Dietary practices of adolescents in Singapore and Malaysia.

INTRODUCTION: This study sets out to investigate any differences in dietary practices between adolescents in Singapore and Malaysia. METHODS: An adolescent dietary practices survey was conducted in Singapore and Malaysia involving 200 adolescents (100 from each country) aged 11 to 21 years in order to have a better understanding of the adolescents' dietary practices. Dietary practices were assessed by a self-administered dietary practices questionnaire (DPQ). RESULTS: The major differences identified between adolescents' dietary practices in Singapore and Malaysia are related to alcohol consumption and venue for taking of lunch. More Malaysian adolescents have their lunch prepared at home (32.9 percent), compared with 7.2 percent of Singaporean adolescents. More adolescents in Malaysia drink alcohol (49.4 percent), compared with only 21.7 percent of Singaporean adolescents. CONCLUSION: From the dietary practices survey of adolescents from Singapore and Malaysia, it may be concluded that while general dietary practices are similar, the major differences identified were significantly (p-value is less than 0.05) higher alcohol consumption by Malaysian adolescents and significantly (p-value is less than 0.05) more Malaysians took their lunch at home compared with Singaporeans. The reasons for the differences are discussed in the paper.

Adolescent↗
PubMed2005

Managing hearing loss in children and adults: Singapore context.

Hearing loss is common in Singapore, with as many as 360,000 persons affected. With Singapore's ageing population, this prevalence is expected to increase. Modern hearing devices have the potential to restore hearing in most patients. Cochlear implants can restore hearing in those with even profound total hearing loss, by stimulating the auditory nerve directly without the need for viable cochlear hair cells. A holistic approach to managing deafness is necessary, including addressing psychosocial issues. Many of the problems experienced by the hearing-impaired are caused by the ignorance and lack of understanding from other people around him/her. "Reverse education therapy" refers to the effective education of these people, to directly benefit the hearing-impaired. In children, hearing restoration together with early detection and effective rehabilitation enable up to 80% to 90% of those born with significant hearing loss to cope well in mainstream education. The infrastructure to support them and facilitate their integration into mainstream society is necessary, and some of these are in place in Singapore. Leisure time noise-induced hearing loss in children is becoming increasingly important. In adults, societal support and understanding are just as important, particularly towards the elderly and pre-lingually deafened adults. Public education in Singapore is necessary, including that on the recognition of the abilities of successfully treated individuals, as well as that on showing more compassion, support and patience towards those who have not benefited sufficiently from treatment. In the future, there is potential for the clinical application of cochlear hair cell/auditory nerve preservation and regeneration.

Adult↗
PubMed2005

The early years of pathology as a specialty in Singapore.

During the first 86 years of Singapore's medical history (1819 to 1905), nobody was officially designated a "pathologist" although pathology was practised. All pathological work (purely medical or forensic) was done by non-specialist doctors. Representative cases are quoted so that conclusions can be drawn regarding what pathological practice was like and the problems faced. In 1905, the Governor, concerned about the high death rate in Singapore, consulted the Principal Civil Medical Officer, who advised that the most effective means to reduce the death rate was the establishment of a Department of Pathology with a full-time specialist pathologist in charge. Dr GA Finlayson was appointed the first Government Pathologist, responsible for all the hospitals in Singapore. He was also appointed Lecturer in Pathology in the Medical School. Work in the Pathology Department increased by leaps and bounds, and no research was possible. The first Annual Report of the Department (1907) is quoted in some detail to show the scope of the work done, reflecting the public health conditions of Singapore a hundred years ago. The Department gradually expanded and more staff were recruited. The new position of Government Bacteriologist was created. This officer served under the Government Pathologist in the Pathology Department.

History, 19th Century↗
PubMed2006

Microalbuminuria prevalence study in hypertensive patients with type 2 diabetes mellitus in Singapore.

INTRODUCTION: Microalbuminuria is a marker of increased cardiovascular morbidity and mortality. It represents the earliest clinical evidence of diabetic nephropathy. Its early detection allows for implementation of individually-tailored cardiovascular risk reduction management programmes. Despite this, information on the prevalence of microalbuminuria in hypertensive patients with type 2 diabetes mellitus in Singapore is limited. METHODS: The Microalbuminuria Prevalence Study (MAPS) assessed the prevalence of macroalbuminuria and microalbuminuria in consecutively-screened hypertensive adult patients with type 2 diabetes mellitus in ten Asian countries. This paper presents the results of a sub-analysis of data from patients in Singapore. RESULTS: Singapore contributed seven percent of the overall enrolment into MAPS; a total of 499 patients were enrolled and 388 constituted the per-protocol population (patients with bacteriuria and haematuria were excluded). Overall, the prevalence of diabetic kidney disease was high. In our study population, 23.5 percent of patients had macroalbuminuria (95 percent confidence interval [CI] 21.3-25.6), and 48.5 percent of patients had microalbuminuria (95 percent CI 45.9-51.0). Only 28.1 percent (95 percent CI 25.8-30.4) of patients were normoalbuminuric. Associated factors were poor glycaemic control and poor blood pressure control. CONCLUSION: The high prevalence (72 percent) of microalbuminuria and macroalbuminuria found in hypertensive patients with type 2 diabetes mellitus in Singapore is a cause for concern. These findings highlight the need to screen for microalbuminuria and better manage hypertensive patients with type 2 diabetes mellitus, if we are to avoid a major increase in end-stage renal disease.

Albuminuria↗
PubMed2006

Rising trends of STIs and HIV infection in Singapore-- a review of epidemiology over the last 10 years (1994 to 2003).

INTRODUCTION: This is a review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1994 to 2003. MATERIALS AND METHODS: Data collated for both notifiable and non-notifiable STIs from 1994 to 2003 were analysed. This data consisted of STI notifications from medical practitioners in Singapore as well as from the Department of STI Control clinic itself. RESULTS: There was a decline in the overall STI incidence in Singapore in the first half of the last decade from 215 cases per 100,000 population (7,200 cases) in 1994 to 162 cases per 100,000 population (6,318 cases) in 1999, followed by an increasing trend in the number of acute STIs (both bacterial and viral) over the past 5 years to 195 cases per 100,000 population (8,175 cases) in 2003 (P <0.001). The incidence of HIV has risen sharply over the last decade whilst that of other viral STIs has not decreased. Singaporeans are becoming sexually active at a younger age, with casual partners constituting the main primary contacts. CONCLUSIONS: Although there has been a significant decline in the overall incidence of STIs in Singapore over the last decade, a rise in acute STIs over the last 5 years has resulted in the need to identify the causal factors, and to intensify existing as well as develop new STI/HIV prevention programmes for the general population and certain core groups.

Adolescent↗
PubMed1990

Cigarette smoking among school children in Singapore. Part I--Smoking prevalence.

A cross sectional nationally representative survey of 33,110 school-going children in Singapore aged between 9 and 20 years was carried out to obtain, for the first time, baseline information on smoking among the school-going population in Singapore. The survey was carried out among students attending vocational institutes and public sector schools in Singapore in 1987. The overall smoking prevalence was found to be 2% (3% among boys and 0.2% among girls). Ex-smokers comprised 2% of respondents whilst those who had only experimented with smoking made up 9% of the respondents. Analyses of the data showed that cigarette smoking was more prevalent among Malays, among boys, among older children, and among the less academically inclined. On average, boys smoked a median of 20 cigarettes a week and girls, 12 cigarettes a week. On an international basis, the smoking prevalence among the school-going population in Singapore is significantly lower than that of developed countries like Australia, England and Wales and neighbouring countries such as Malaysia.

Adolescent↗
PubMed1989

The social position and internal organization of the medical profession in the Third World: the case of Singapore.

This paper probes two aspects of the medical profession in Singapore: its structure and its social position. The first section reviews the relevant concepts concerning the structure and the social position of the professions that may be applied to medicine in Singapore. The second section looks into the structure of the medical profession in Singapore from an historical perspective. The third section deals with the internal organization of the medical profession. The fourth section focuses on its social position. The paper concludes with a summary of the main points and a brief comparison of the situation in Singapore with that in other countries.

Clinical Medicine↗
PubMed1988

A study of the mortality patterns of taxi drivers in Singapore.

The mortality patterns of taxi drivers in Singapore were studied by examining the death certificates of a group of taxi drivers from 1984 to 1986. The drivers were all members of Singapore's largest transport co-operative, with a fleet of 6,377 taxis. This represents over 60% of all taxis in Singapore. One hundred deaths occurred among the taxi drivers during these 3 years. The age and sex standardised mortality ratios (SMRs) were 0.70 in 1984, 0.72 in 1985, and 0.98 in 1986. For the whole period, the age and sex standardised SMR was 0.80 (95% CL 0.65-0.97). Leading causes of death were neoplasms (42%), coronary heart disease (24%), and cerebrovascular disease (15%). Age and sex standardised cause specific SMRs were 1.22 (95% CL 0.88-1.65) for neoplasms, 0.78 (95% CL 0.50-1.16) for coronary heart disease, 1.51 (95% CL 0.84-2.49) for cerebrovascular disease, and 1.03 (95% CL 0.28-2.63) for suicides and homicides. Death from all other causes was significantly lower than the general population (SMR 0.32, 95% CL 0.18-0.53). As compared to the general population, taxi drivers in Singapore do not appear to have an excess mortality risk for cancers, coronary heart disease, cerebrovascular disease or from all other causes of death. Their risk of violent death from homicide or suicide is low when compared to available reports from other countries.

Adult↗
PubMed1982

Research and development in obstetrics & gynaecology in the Department of Obstetrics & Gynaecology at the National University of Singapore.

This is a review of the research and achievements of the Department of Obstetrics and Gynaecology, National University of Singapore since 1949. The research activities reviewed are Fertility Control, Subfertility, Reproductive Endocrinology, In-Vitro Fertilization, Trophoblastic Disease, Prostaglandins and Perinatal Medicine. The University Department has kept abreast with the Singapore norm of two-child families by providing the most sophisticated technology and expertise. The perinatal mortality and stillbirth rates have been reduced to 11 and 6 per thousand births. Prostaglandin research in the Department includes an investigation of the involvement of these substances in various physiological processes, pharmacological studies with different prostaglandins and development of clinical applications. Between 1974 and 1981 we had studied 12 intrauterine contraceptive devices, both on a departmental basis and in conjunction with international agencies. The newer medicated devices have proved to offer significant advantages over the original inert plastic configuration. Metabolic changes in Singapore women on the oral pill and injection Depoprovera were studied. Impaired glucose tolerance and raised fasting total lipids were found in women on the pill. Marginal changes in carbohydrate metabolism only were found in women on injection Depoprovera. Hypercoagulation changes in the blood occurring in Singapore women varied with the dose of the synthetic or natural oestrogen medication. Initially, the fibrinolytic activity was enough to compensate for these changes; however after two years there were signs of decompensation. Progestogens affect coagulation via their influence on the liver functions. Hypercoagulation changes also occurred in pregnancy and was of a greater magnitude than oestrogen or progestogen medication. In many obstetric disorders, including hydatidiform mole, there was evidence of intravascular coagulation. The introduction of endocrine function tests has greatly improved patient care in our Department, in particular those related to endocrine disorders. Application of the immunoassays to basic research has shown that physiological levels of oestradiol exert a negative feedback effect on both FSH and LH secretions in men. The greater suppression of LH than of FSH secretion by pharmacological doses of estradiol is possibly due to different control mechanisms in the pituitary for the synthesis and release of both gonadotrophins. Physiological level of testosterone per se has a definite negative feedback effect on the secretion of LH but not on FSH. Pharmacological doses of the 5-alpha-reduced metabolites of testosterone have been shown to suppress both LH and FSH indicating that some of the actions of testosterone could be medicated by these metabolites of which the 3 alpha-androstanediol and 3 beta-androstanediol are the more likely candidates.

Academic Medical Centers↗
PubMed1982

The development of and recent trends in occupational health in Singapore.

Occupational health in Singapore developed largely over the past 10-15 years. The rapid progress in general awareness, personnel, services, education and research, is described. The role of Singapore as a regional centre for education, consultancy service and research is increasing. The development and functions of government agencies, the University, statutory boards and voluntary organizations are discussed. Common occupational diseases include pneumoconiosis, metal poisoning, occupational dermatitis, noise-induced deafness and psychological disturbances. Evidence suggests gross under-reporting of these conditions. About 150 research papers concerning occupational health in Singapore have been published so far. There can be little doubt that the importance of the discipline will gather even greater momentum in Singapore in the future.

Humans↗
PubMed1982

Cancer incidence in Singapore: 1973-77.

The Singapore Cancer Registry started operations on January 1, 1968. It is a population-based registry that seeks to obtain basic epidemiological and clinical data on all cases of cancer diagnosed in Singapore. The results presented pertain only to Singapore citizens and permanent residents and cover the period from 1973 to 1977. Of special interest are the cancer patterns of the main ethnic groups in Singapore. Generally, the Chinese (76% of total population) have significantly higher risks for cancer; the most prevalent sites are the nasopharynx, esophagus, stomach, liver, and lung. Within the Chinese group are also dialect group differences. The Malays (15% of population) have the lowest rates for most sites, whereas among the Indians (7% of population), mouth cancer is an important site for both sexes. All these variations provide useful clues in the search for etiological factors.

China↗
PubMed1996

Glucose-6-phosphate dehydrogenase deficiency in Singapore.

Glucose-6-phosphate dehydrogenase (G6PD) in man is an X-linked enzyme. The deficiency of this enzyme is one of the most common inherited metabolic disorders in man. In Singapore, three clinical syndromes associated with G6PD deficiency had been described: severe haemolysis in neonates with kernicterus, haemoglobinuria and "viral hepatitis"-like syndrome. The human G6PD monomer consists of 515 amino acids. Only the tetrameric or dimeric forms composed of a single type subunit are catylitically active. The complete amino acid sequence of G6PD had been elucidated in man and various other animals. The region of high homology among the enzymes of various animals is presumably functionally active. Among the Chinese in Singapore, three common molecular variants had been identified: Canton (nt 1376 G --> T), Kaiping (nt 1388 G --> A) and Mediterranean (nt 563 C --> T) in frequencies of 24%, 21% and 10% respectively. In addition, two common mutants (Gaozhou, nt 95 A --> G and Chinese 5, nt 1024 C --> T) have been detected in Singapore Chinese in low frequencies. In Malays, 6 different deficient variants are known in Singapore (3 new, 1 Mahidol, 1 Indonesian and 1 Mediterranean).

Female↗
PubMed1995

Corneal ulcers in two institutions in Singapore: analysis of causative factors, organisms and antibiotic resistance.

The aim of this study was to determine the causative factors, organisms and antibiotic resistance in patients with bacterial keratitis in Singapore. We analysed retrospectively 103 cases of bacterial keratitis admitted to the Singapore General Hospital or the Singapore National Eye Centre during a 21-month period from March 1992 to December 1993. Contact lens wear represented the largest single predisposing factor (35 eyes, 34.0%), followed by ocular trauma (28 eyes, 27.2%) and pre-existing ocular disease (28 eyes, 27.2%). Thirteen of the twenty-eight cases of trauma-related keratitis were work-related injuries. Gram-negative organisms formed the largest group (41 cultures, 80.4%), with Pseudomonas aeruginosa being the most common organism identified (30 eyes). Pseudomonas was also responsible for 78.6% of all contact lens ulcers (11 out of 14 eyes). Resistance to gentamicin was only encountered in 1 case of Proteus mirabilis keratitis. All cases of Pseudomonas infection and 3 of the 10 Gram-positive cases were also resistant to chloramphenicol. All Gram-positive cases were sensitive to cephalosporins. Contact lens wear and ocular trauma are the major preventable risk factors for bacterial keratitis in young sighted eyes in Singapore. Gentamicin continues to be the antibiotic of choice for Gram-negative corneal infections in view of the low incidence of resistance. The routine use of chloramphenicol as the topical antibiotic of choice for corneal infection is not recommended due to the high resistance in Gram-positive and Gram-negative organisms locally.

Adult↗
PubMed1996

Thirty-eight years of water fluoridation--the Singapore scenario.

The high caries rate in Singapore school children was of great concern to dental administrators. Remedial measures alone were not the solution. The success of water fluoridation in Grand Rapids, USA and in Brantford, Canada in reducing dental caries in children in the early 1950s prompted Singapore to introduce fluoride into its drinking water. Singapore is the first country in Asia to institute a comprehensive fluoridation programme which covers 100 per cent of the population. The water was fluoridated at 0.7 ppm fluoride using sodium silicofluoride. The ten year study on the effects of water fluoridation in Singapore showed a decrease in caries prevalence in the children. In the permanent dentition the reduction was 52.3 per cent for Chinese and 31 per cent for Malays in the 7 to 9 year old age group. A similar trend was observed in the mixed dentition in which the decrease was 32.5 per cent for Chinese and 30.6 per cent for Malays. Because of the availability and use of other fluoride products, dental fluorosis was observed in children in later years. Although the decline in dental caries after 10 years of water fluoridation was not comparable to those achieved in other countries, this study further documents water fluoridation as the most cost-effective public health measure for the prevention of dental caries.

Adolescent↗